by Terri Fisher
Abstract
This brief paper analyzes narrative therapy within a professional construct. The basic premises are discussed and compared with structural therapy including change and role of the therapist. Brief descriptions of applied studies are also included to demonstrate ethical and professional efficacy. A conclusion describes the position of the author.
Narrative Therapy vs. Structural Therapy
Metaphors describe part of the context of Narrative Therapy. White (2007) suggests that metaphors provide a way for individuals to describe and present the problem that is occurring in their lives. In doing so, they are able to find meaning and value for the problem. The process of finding a theory from which to practice is similar to the process of entering this PhD program. It is a rollercoaster of dips, turns, drops, loops, and changes in speed that propel one through a journey that is exhilarating and exhausting at the same time. Some people have described the process of therapy in the same way.
Narrative therapy began with discussions between Michael White and David Epston in the early 1990s (Wallis, Burns, and Capdevila, 2011) It was a natural progression from the scope of practice which discussed how people told stories and described their lives. It is a strength based theory which believes that individuals are the experts on their lives. It is a practice that evolves through discourses between client and therapist. Consequently, it is led by the client. The therapist acts as a safari guide to assist the client. As a guide, the therapist provides the options and maps which take the client where she wants to go in order to find the things she values most.
This practice is in stark contrast to other more directive approaches such as structural therapy. Structural therapy is conducted with a therapist who directly intervenes and coaches the individual and family members to interact in different ways (Minuchin, 1974). It provides specific instructions and assignments which promote change through direct relational interactions. Change is possible in both methods. Narrative therapy is client directed change whereas structural therapy is therapist directed change.
The role of the therapist is also different in these two methods. Narrative therapists act as guides to provide support and be with the client in her journey of self-discovery (Bertrando, 2011). The therapist walks with the client in her journey in an empathetic and empowering stance. Conversely, structural therapists act as the orchestra conductor (Minuchin, 1974). The therapist has the score and directs each member to play according to her preferences. These preferences are based on experience and knowledge related to what works well and how the final piece should sound. Each therapeutic role provides opportunities for change to occur although one is directive and the other collaborative.
Narrative therapy assumes that the problem is created and expressed because of discourses that are not intrinsic to the person. The individual begins to experience chaos and confusion as she attempts to map a destination where she does not want to go. Externalizing conversations are a process by which an individual may begin to view herself as separate from the problem (Vetere and Dallos, 2008). In a sense, the problem becomes the problem rather than the individual being the problem. Separation from the problem provides opportunities for the individual to see herself as under the influence of a problem rather than the problem itself.
As an individual becomes more expert in her life, the influence of the problem becomes tenuous. This new identity forms within the construct of individual values and beliefs that align more with how she sees herself (Wallis, Burns, and Capdevilla, 2011). These more salient views promote a separation from the dominant discourses that have influenced her. The old discourses were not inherently a part of what she valued. Consequently, as the newer and more inherent constructs form, she is able to align herself with those views that inherently fit. Thus, the problem is further removed from her.
Landscapes of change begin to form through the process of scaffolding. Butler and Bird (2000) describe scaffolding as a process in which incremental goals are self-initiated and tried on for fit. These incremental goals are discovered as the individual begins to find her own unique outcomes. These unique outcomes are the times that already occur when the problem has less hold on the individual. Often, she has been unable to see the unique outcomes due to the influence of the problem. Detecting the unique outcomes provides hope while offering opportunities to describe valuable moments of relief. Goals within the scaffolding framework are then constructed and practiced. Through this practice, the individual is able to manage and tweak differences to create more unique outcomes of personal and self-directed success.
In a study by Miller and Forrest (2009) the ethics of narrative therapy were compared with the American Counseling Association (ACA) code of ethics. Two case studies were reviewed. The therapists in these studies used narrative therapy. One of the cases involved a family. Miller and Forrest (2009) describe that the ACA code of ethics requires the therapist to define the client. In this specific case involving abuse, the therapist was clear to differentiate the roles of family therapist and individual therapist. Describing and clarifying this information at every session promotes opportunities for adjustment within the therapeutic relationship.
Another study by Chan, Ngai, and Wong (2012) tested the use of narrative therapy in a case with a woman struggling with substance abuse. This study served as a pilot program for a hospital in Hong Kong. Through the use of externalization, scaffolding, proximal development, the use of photographs, and distancing tasks, the woman was able to gradually reduce her substance use to the point of no use. This hospital served as a rehabilitation center in Hong Kong.
Narrative therapy resonates with me personally and professionally. Coming from a background of problem saturated stories, it was liberating to finally understand that I was not a problem, the problem is the problem. From a professional view, it is not my nature to direct and tell people what to do. As a Marriage and Family Therapist, I am able to use directive methods, such as structural family therapy, to provide direction and relief for families who are struggling. Insurance companies are becoming more directive as to how long a family may be in therapy. There may not be time for self-guided approaches. In cases where immediate change is necessary, such as domestic violence situations, directive methods provide specific and direct change in the moment within relational constructs.
Given the time and option, narrative therapy resonates within my psyche. It provides the opportunity to value and appreciate the individual and family position. It takes into consideration the cultural beliefs and values which are intrinsically healthy and productive. Additionally, it provides the context for client centered conversations where families and individuals are able to explore and relate to difficult and challenging life circumstances. These challenges are often found in dominant discourses that may not be the beliefs and values of the individuals. Consequently, families are able to examine these discourses and decide what value they have. In this process, they create a roller coaster of events and experiences which eventually end at the destination of their choice.
References
Bertrando, P. (2011). A theory of clinical practice: the cognitive and the narrative. Journal of Family Therapy, 33, 153-167.
Butler, M.H., and Bird, M.H. (2000). Narrative and interactional process for preventing harmful struggle in therapy: An integrative model. Journal of Marital and Family Therapy, 26(2), 123-142.
Chan, C., Ngai, K.H., and Wong, C.K. (2012). Using photographs in narrative therapy to externalize the problem: A substance abuse case. Journal of Systemic Therapies, 31(2), 1-20.
Miller, P., and Forrest, A.W. (2009). Ethics of Narrative Therapy. The Family Journal, 17(2), 156-159.
Minuchin, S. (1974). Families & family therapy. Cambridge, MA: Harvard University Press.
Vetere, A., and Dallos, R. (2008). Systemic therapy and attachment narratives. Journal of Family Therapy, 30, 374-385.
Wallis, J., Burns, J., and Capdevila, R. (2011). What is narrative therapy and what it is not? The usefulness of Q methodology to explore accounts of White and Epston’s (1990) approach to Narrative therapy. Clinical Psychology and Psychotherapy, 18, 486-497.
White, M. (2007). Maps of narrative practice. NY: Norton.